Posted by Are you worried about replacing your broken retainer? This article explores whether dental insurance covers retainer replacements, factors affecting costs, tips to maximize your benefits, and many more.
From research, the American Association of Orthodontists discovered that about 25% of their patients lose or damage their retainers within the first year of receiving them. Interestingly, over 90% of individuals in the US require retainers for life to maintain their straightened smiles.
The shocking news is that replacing your damaged retainer from your pocket is no piece of cake at all. Typically you will be spending around $150 to $500 and that depends on the type of retainer you’re about to replace and the quality of its material.
Don’t worry we are here to ease your mind. So let’s tackle the issue of your insurance and how it helps you get back your retainers.
Table of Contents
Does Dental Insurance Cover Retainer Replacement?
Yes, some dental insurance companies do offer partial coverage for retainer replacement. In rare cases, some plans may be generous enough to offer you full coverage for your damaged retainers.
Unfortunately, some people do not get any coverage at all for retainer replacement because not every plan offers you coverage for retainer replacement. Some specific plans offer little or no coverage at all for retainer replacements leaving you to carry the burden of your damage all alone.
As you can already guess, it all depends on your specific plan and how its policy handles orthodontic treatments.
We advise you to check your plan to know whether you stand a chance to benefit from getting coverage for retainer replacement or if you should just prepare your wallet for the cost of replacing your retainer.
How your Type Of Dental Plan Can Influence your Coveage for Retainer Replacement
Here are the three main types of Dental insurance plans and how they respond differently to retainer replacement:
1. Preventive Plans:
If your plan focuses on routine cleanings and exams that is Preventive dental care, then it is most likely that you will not be offered dental insurance coverage for orthodontic treatment services which includes retainer replacement or at best you may only get minimal coverage for retainer replacement.
2. Basic Plans:
If you have a basic plan you might be more liable to be covered for retainer replacement than others who may be having preventive plans. Basic dental insurance plans sometimes cover basic orthodontic treatments and in such a case you may get partial coverage for retainers replacement as part of your orthodontic treatment package. But it still depends on the policy of your plan.
3. Major Plans:
Having a major dental insurance plan could be a bonus for you because major plans offer you the most comprehensive coverage for retainer replacements and other orthodontic treatments.
You may even get coverage for one complimentary retainer from some plans. However, some other plans may only offer partial coverage for retainer replacement within a specific period.
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2-Ways Dental Insurance Cover Retainer Replacements
Below are the 2 main ways dental insurance covers retainer replacement:
#1. Retainer Replacement Coverage for Loss, Damage, Wear and Tear
You may get full coverage for the retainer replacement of a lost, damaged, or worn-out retainer though the chances to get this kind of retainer replacement coverage are very rare but it does exist mostly if your plan is focused on orthodontics.
However, it is very likely for you to get a partial coverage of about 25%-50% for retainer replacement. Leaving you responsible for the rest of the cost.
If you have a lower-tier or basic plan you may not get any coverage at all for retainer replacement because they’re excluded altogether. You’ll have to bear the full cost of your retainer replacement.
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#2. Coverage for Periodic Retainer Replacement
Some plans cover retainer replacement at specific time intervals say once in 2 years. This means you get the opportunity to get full coverage for retainer replacement every once in 2 years. At least these plans afford you the benefit of continuous protection of your teeth at a predictable cost and time.
On the other hand, some dental plans may not offer you any coverage at all for periodic retainer replacement. In this case, you are solely responsible for the cost of replacing your retainers regardless of your reason or how often you come for a replacement. So if you choose to replace your retainers 2 times a year the cost is yours to bear.
7 Factors That Affect Your Level Of Dental Insurance Coverage For Retainer Replacement
Now that you know that some dental insurance plans offer partial or full coverage for retainer replacement, let’s see the factors that determine how much coverage you get:
- Type of Plan
- Percentage Coverage
- Annual Maximum Limits For Retainer Replacements
- The Reason You Want Retainer Replacement
- In-Network Providers
- Frequency Of Getting Retainer Replacement
- Pre-Approval Before Coverage For Retainer Replacement
#1. Type of Plan:
Your type of plan is the principal determinant of your level of coverage for retainer replacement. Having a preventive plan means you stand little or no chance of getting coverage.
Basic plans most likely offer you partial coverage while major plans give you a greater chance of getting covered for retainer replacements.
#2. Percentage Coverage:
Your dental plan documents a specific percentage it covers for retainer replacement. For instance, it may state that you’ll get 50% or 80% coverage for retainer replacement.
If your plan offers minimal or low coverage, then it implies that you get 25%-35% of coverage leaving you with a larger portion of the financial burden.
Your plan may offer a moderate coverage of 40%-50% coverage which helps relieve you of a significant amount of cost or maybe fortunately you can get your retainer replacement.
#3. Annual Maximum Limits For Retainer Replacements
Most dental insurance plans have a specific amount of coverage they can offer you per year. Once you have exceeded this maximum amount on other treatments, you may not be covered for extra expenses like retainer replacement.
But then some other plans allocate a separate annual maximum for orthodontic treatments and that could influence the coverage you get for additional retainers.
#4. The Reason You Want Retainer Replacement:
If your reason for getting a retainer replacement is because of a medical necessity then you’re likely to get coverage but the reverse is the case when your plan considers orthodontic treatments and subsequent retainers purely cosmetic.
So, You may get little or no coverage for retainer replacements which are considered cosmetics.
Hope you are aware that there are dental insurance plans that only cover medically necessary treatments, so if the reason for the replacement is deemed medically necessary by your dentist, you’ll have coverage.
We’d advise you to get a written note from your dentist stating that your case is medically necessary. Such proof will go a long way to benefit you in this regard.
#5. In-Network Providers:
Using an in-network orthodontist might increase your chances of receiving some coverage for retainers compared to out-of-network providers.
#6. Frequency Of Getting Retainer Replacement
Many plans state how often you’ll be covered for specific dental services. So even when your plan covers retainer replacement there might be a limited number of times you get coverage from the dental insurance company for the replacements.
So losing your retainers multiple times a year and expecting coverage now and then may not do you any good.
#7. Pre-Approval Before Coverage For Retainer Replacement
Some plans may demand you get written proof from an orthodontist stating that you need to get a retainer replacement before you’ll be offered any coverage of any sort.
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How To Be Sure Your Dental Insurance Covers Your Retainer Replacement Needs
Below are some ways to be sure your dental insurance covers your retainer replacement needs:
#1. Study your Insurance Booklet:
You cannot use your plan effectively to secure coverage if you do not understand what it says regarding coverage for retainer replacement. Your insurance policy booklet contains all the information you need regarding your benefits as it concerns retainer replacement.
While reading your insurance booklet, deliberately look out for words like retainers, replacements, orthodontic benefits, and annual maximums, and also look out for potential limitations to your coverage for retainer replacements.
#2. Seek The Counsel Of your Dentist:
Your dentist is one of the most reliable sources of information regarding your dental services and that includes your need for retainer replacement. They may have a familiar knowledge of your insurance plan and may provide you with insights on how to go about securing coverage for retainer replacement.
They may also give you a written document that proves to your insurance company that you need a retainer replacement.
#3. Contact your insurance Company
Put a call across to your insurance company without delay if you find any of the terms in your policy unclear. Seek clarifications by asking relevant questions. Find out if your plan offers full, partial, or no coverage at all for retainer replacement.
Find out if there are conditions you must meet to get coverage for instance do you need to get pre-authorization before getting coverage for retainer replacement?
Budget-Friendly Alternative Ways Of Getting Retainer Replacement If You Don’t Have a Dental Insurance Plan
Getting insurance coverage is not the only way out of the heavy cost that comes with retainer replacement. Here are a few proactive alternatives:
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Direct Billing with Your Orthodontist:
If your plan offers limited coverage or comes with high deductibles you can patronize those dentists that offer direct billing plans. These plans are often more affordable alternatives than even insurance. Find out if your dentist offers this service then compare its price with your insurance reimbursement.
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Online Retainer Providers:
You can get custom-made clear retainers from online companies such as Sporting Smiles and smiledirectclub at lower prices compared to what you get from your dentists and orthodontist. It affords you the advantage of taking your impression in your house and then you send it in for fabrication. The quality you get can vary but is an economical solution for simple retainer replacement.
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Retainer Protection Plans:
You can get retainer protection plans from some orthodontists and dentists. Here, you pay a certain fixed annual fee, that covers a certain number of retainer replacements in case you lose your retainers due to loss, wear, tear, or damage.
Check the cost of the plan and the probability of needing a replacement for the many retainers you’re paying for and evaluate if this option is the best for you.
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Handle your retainers with Care:
Handling your retainer with care is the surest way not to need a replacement in the first place or at least greatly reduce how often you’d need a replacement.
Tips on How To Care For Your Retainer
- Use lukewarm water and a mild soap to clean your retainers regularly
- When you don’t need them, store them in a clean, dry case.
- Do not expose them to extreme cold or heat.
- You should be careful not to drop or bend them.
Frequently Asked Questions
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Important Recommendation
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- Does Dental Insurance Cover Bonding?
- Does Dental Insurance Cover Oral Cancer Screening?
Conclusion
When it comes to coverage for retainer replacement make it your priority to understand your type of plan. For further clarifications contact your insurance provider and seek the counsel of your dentist.
As always taking care of your belongings never runs out of profits. Caring for your retainers is the best way to save you the stress of seeking a replacement.